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      Insulin resistance quantified by the value of HOMA-IR and cardiovascular risk in patients with type 2 diabetes

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          Abstract

          Cardiovascular disease (CVD) is recognized as a leading cause of death worldwide. Obesity, dyslipidemia, insulin resistance (IR), interconnected pathological conditions constitute risk factors that are closely associated with CVD. The aim of the present study was to highlight the association of IR with cardiovascular risk (CVR). The epidemiological, cross-sectional, non-interventional study was conducted over 12 months (2019-2020) within a research grant and included a sample of 400 subjects divided into 2 subgroups: group 1 (control) subjects did not have diabetes (n=200) and group 2 had type 2 diabetes (T2DM) (n=200). The Framingham risk score (FRS) was calculated according to the 2008 general CVD risk model from the Framingham Heart Study. Subsequent to a correlation of the value of homeostasis model assessment of insulin resistance (HOMA-IR) with the degree of CVR, the IR was higher in both groups, and CVR also increased. After being quantified by the Spearman correlation coefficient, the correlation in group 2 was higher at 0.625 compared to group 1 where this coefficient had a value of 0.440. A high FRS (FRS of 20%) was significantly associated with IR. The results therefore show that HOMA-IR is an independent risk factor for high FRS. New therapies focused on decreasing IR may contribute to decreased CVD.

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          General cardiovascular risk profile for use in primary care: the Framingham Heart Study.

          Separate multivariable risk algorithms are commonly used to assess risk of specific atherosclerotic cardiovascular disease (CVD) events, ie, coronary heart disease, cerebrovascular disease, peripheral vascular disease, and heart failure. The present report presents a single multivariable risk function that predicts risk of developing all CVD and of its constituents. We used Cox proportional-hazards regression to evaluate the risk of developing a first CVD event in 8491 Framingham study participants (mean age, 49 years; 4522 women) who attended a routine examination between 30 and 74 years of age and were free of CVD. Sex-specific multivariable risk functions ("general CVD" algorithms) were derived that incorporated age, total and high-density lipoprotein cholesterol, systolic blood pressure, treatment for hypertension, smoking, and diabetes status. We assessed the performance of the general CVD algorithms for predicting individual CVD events (coronary heart disease, stroke, peripheral artery disease, or heart failure). Over 12 years of follow-up, 1174 participants (456 women) developed a first CVD event. All traditional risk factors evaluated predicted CVD risk (multivariable-adjusted P<0.0001). The general CVD algorithm demonstrated good discrimination (C statistic, 0.763 [men] and 0.793 [women]) and calibration. Simple adjustments to the general CVD risk algorithms allowed estimation of the risks of each CVD component. Two simple risk scores are presented, 1 based on all traditional risk factors and the other based on non-laboratory-based predictors. A sex-specific multivariable risk factor algorithm can be conveniently used to assess general CVD risk and risk of individual CVD events (coronary, cerebrovascular, and peripheral arterial disease and heart failure). The estimated absolute CVD event rates can be used to quantify risk and to guide preventive care.
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            Homeostasis model assessment: insulin resistance and ?-cell function from fasting plasma glucose and insulin concentrations in man

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              2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2021

              (2020)
              The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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                Author and article information

                Journal
                Exp Ther Med
                Exp Ther Med
                ETM
                Experimental and Therapeutic Medicine
                D.A. Spandidos
                1792-0981
                1792-1015
                January 2022
                24 November 2021
                24 November 2021
                : 23
                : 1
                : 73
                Affiliations
                [1 ]Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
                [2 ]Department of Emergency, Emergency Clinical County Hospital of Craiova, 200349 Craiova, Romania
                [3 ]Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
                [4 ]Department of Internal Medicine, Emergency Clinical County Hospital of Craiova, 200642 Craiova, Romania
                [5 ]Department of Hygiene, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
                [6 ]Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
                [7 ]Department of Pneumology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
                Author notes
                Correspondence to: Professor Mircea-Cătălin Forțofoiu, Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rareș Street, 200349 Craiova, Romania catalin.fortofoiu@ 123456umfcv.ro

                Dr Rodica Pădureanu, Department of Internal Medicine, Emergency Clinical County Hospital of Craiova, 1 Tabaci Street, 200642 Craiova, Romania zegheanurodica@ 123456yahoo.com

                *Contributed equally

                Article
                ETM-0-0-10996
                10.3892/etm.2021.10996
                8649857
                34934444
                14c9a9ef-b5d3-416c-a906-adbcd42975ee
                Copyright: © Vladu et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                : 03 September 2021
                : 05 October 2021
                Funding
                Funding: This work was supported by the by dates obtained from the grant (research contract no. 49/09.09.2019) with the research topic: Cardiovascular risk assessment in patients with type 2 diabetes conducted by Ionela Mihaela Vladu, as project director, in collaboration with the ‘The Holy Apostles Medical Center’ and the University of Medicine and Pharmacy Craiova.
                Categories
                Articles

                Medicine
                insulin resistance,type 2 diabetes mellitus,homa-ir,cardiovascular risk
                Medicine
                insulin resistance, type 2 diabetes mellitus, homa-ir, cardiovascular risk

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